| flw_consent_text |
|
text |
Your permission to proceedThank you for coming this far. Now to take part, please readthe statements below, and initial the boxes if you're happy togo ahead. |
|
| flw_consent_init |
|
yesno |
I give my consent for the information I provide in this study to be used as advised |
1, Yes ; 0, No |
| flw_consent_verbal |
|
radio |
Verbal consent given? |
1, Yes |
| flw_consent_no_init |
|
text |
NOTE: Unless 'I give my consent for the information I provide in this study to be used as advised' is answered as Yes, the questions in the follow-up survey form will not be visible |
|
| flw_consent_3_6m |
|
yesno |
I give my consent for this survey to be sent to me in 3 to 6 months' time, and over the course of the next 3 years. |
1, Yes ; 0, No |
| flw_consent_phone |
|
yesno |
I would like the possibility to be contacted by a nurse, doctor or researcher to discuss my COVID-19 illness further |
1, Yes ; 0, No |
| flw_phone |
|
text |
If yes, please enter your telephone numbers below: Telephone: |
|
| flw_mobile |
|
text |
Mobile phone: (Start with 07 then enter rest of mobile number) |
|
| flw_consent_signed |
|
yesno |
Patient / Adult's signature provided? |
1, Yes ; 0, No |
| flw_consent_date |
|
text (date_dmy) |
Date consent provided |
|
| follow_up_consent_complete |
Form Status |
dropdown |
Follow up Consent section complete? |
0, Incomplete ; 1, Unverified ; 2, Complete |